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Unintentional injury is a leading cause of childhood death and disability in the U.S. Notably, atypically-developing children are at greater risk for unintentional injuries than their typically developing peers. A key question is how to prevent these injuries in both typically- and atypically-developing children. As children gain independence, responsibility for the regulation of risky behaviors must transfer from parents to children. This likely happens in a variety of ways, one of which is parent-child conversations about safety. Past work has examined the content of parent-child safety conversations in typically-developing children and found that mothers use disagreements, supported by references to dangerous features of the activity and the adverse outcomes that might result, as a means of bringing children around to their own way of thinking about safety. Still unknown is what these conversations look like while parents and children are engaged in common, yet potentially unsafe activities, such as crossing roads with traffic. Nor do we know what these conversations look like in at-risk populations, such as children with ADHD. Evidence points to poor executive function and oppositionality, commonly comorbid with ADHD, as driving the increased injury risk in this population. We assessed parent-child safety conversations in real time while parents and their children (with and without ADHD) were engaged in a simulated risky activity: crossing traffic-filled roads in our pedestrian simulator. Recorded conversations were coded and parents completed several questionnaires and diagnostic assessments regarding their and their child’s ADHD symptoms. While fewer symptomology differences related to parent-child conversations emerged than initially anticipated, many that did were primarily driven by oppositionality. These findings support previous claims that oppositionality increases injury risk in this population and contributes to poorer parent-child interactions.

Child maltreatment (CM) and unintentional childhood injury affects millions of children and cost society billions of dollars annually. The population at risk for CM has congruent demographic characteristics as children that are more likely to have unintentional injuries. Preventing CM through evidence-based home-visiting programs has been shown effective and cost efficient, and the inclusion of home safety in such programs, demonstrates significant reduction of hazards in the home. The overarching goal of the current research is to make a statistical connection between the population at risk for CM and amount of hazards in the home; that these two populations have enough overlap to validate the inclusion of home safety components in CM prevention programs. This study uses data from an ongoing research project that braids two evidence-based parenting programs: SafeCare® and Parents as Teachers. Findings indicate that the correlation between potential for abuse, measured by BCAP scores, and hazards in the home, measured by the HAPI, show a significant correlation r = .23, p < .05. Other variables such as loneliness, distress, and marital status were also found to contribute to this relationship.

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ABSTRACT The purpose of this research study is to determine if the rate of unintentional injury death in selected medical districts differs significantly among citizen and non-citizen males ages 20-65 living in the United Arab Emirates (UAE). A profile of unintentional injury deaths was generated by specific cause for the six medical districts of Ajman, Dubai, Fujairah, Ra’s al-Khaimah, Sharjah and Umm al-Qaiwain managed for the UAE Ministry of Health for the years 2006-2008. During this time period the six medical districts reported a total of 14,101 deaths. Males were found to represent 73.9 per cent of the deaths reported by the six medical districts managed by the UAE Ministry of health for the years 2006-2008. Non –citizen males represented 74.8 per cent of the male fatalities reported by the six medical districts managed by the UAE Ministry of health for the years 2006-2008. Fatality rates for males ages 20-65 were generated and analyzed by citizen status and season of the year. This age group represented 6,141 deaths. In the two medical districts with the highest population (Dubai & Sharjah) unintentional injury deaths represented 77.1% of the total unintentional deaths reported by all the six medical districts managed by the UAE Ministry of Health for the years 2006-2008. A Chi-Square found the rate of fatalities among 20-65 years old male citizens and non-citizens in the six medical districts managed by the UAE Ministry of Health for the years 2006-2008 differed significantly by cause of unintentional injury death. The observed rate of death from accidental falls for non-citizen 20-65 males was found to be higher than expected for male citizens in the same age group. The observed unintentional injury death rate for males ages 20-65 caused by motor vehicle & traffic accidents and for accidental poisoning found the death rate for UAE citizens to be higher than the rate for non-citizens living in the UAE. The results of this study demonstrate the need for the reporting and analysis of unintentional deaths at the medical district level in the UAE by subgroups such as citizen status and age group.

The focus of this study is the vicious circle of poverty and ill-health. The case is injuries but it could have been any lasting and severe disease. Poverty and health have very close links to economic development and to how health care is financed. Out-of-pocket payment seems to increase the risk of poverty while prepaid health care reduces it. The overall objective is to investigate the “injury poverty trap” and suggest possible solutions for it. A cohort of 23,807 people living in 5,801 households in Bavi district of Vietnam was followed from 1999 to 2003 to investigate income losses caused by non-fatal unintentional injuries in 2000 as well as the relationships between social position in 1999 and those injuries. For the possible solutions, a survey in 2064 household was performed to elicit people’s preferences and willingness to pay for different health care financing options. The results showed that unintentional injuries imposed a large economic burden on society, especially on the victims. By two pathways – treatment costs and income losses – unintentional injury increased the risk of being poor. The losses for non-poor and poor injured households were about 15 and 11 months of income of an average person in the non-poor and poor group, respectively. Furthermore, poverty was shown to be a probable cause of non-fatal unintentional injuries. Specifically, poverty led to home injuries among children and the elderly, and adults 15 – 49 years of age were particularly at risk in the workplace. The middle-income group was at greatest risk for traffic injuries, probably due to the unsafe use of bicycles or motorbikes. About half of the population preferred to keep an out-of-pocket system and the other half preferred health insurance. People’s willingness to pay suggested that a community-based health insurance scheme would be feasible. However, improvements in the existing health insurance systems are imperative to attract people to participate in these or any alternative health insurance schemes, since the limitations of the existing systems were generalized to health insurance as a whole. A successful solution should follow two tracks: prepayment of health care and some insurance based compensation of income losses during the illness period. If the risk of catastrophic illness is more evenly spread across the society, it would increase the general welfare even if no more resources are provided.

The main objective of this epidemiological study was to assess the incidence of unintentional non-fatal injuries, together with their determinants and consequences, in a defined Vietnamese population, thus providing a basis for future prevention. A one-year follow-up survey involved four quarterly cross-sectional household injury interviews during 2000. This cohort study was based within a demographic surveillance site in Bavi district, northern Vietnam, which provides detailed, longitudinal information in a continuous and systematic way. Findings relate to three phases of the injury process: before, during and after injury. The study showed that unintentional non-fatal injuries were an important health problem in rural Vietnam. The high incidence rate of 89/1000 pyar reflected almost one tenth of the population being injured every year. Home injuries were found to be most common, often due to a lack of proper kitchens and dangerous surroundings in the home. Road traffic injuries were less common but tended to be more severe, with longer periods of disability and higher unit costs compared with other types of injury. The leading mechanisms of injury were impacts with other objects, falls, cuts and crushing. Males had higher injury incidence rates than females except among the elderly. Elderly females were often injured due to falls in the home. Being male or elderly were significant risk factors for injury. Poverty was a risk factor for injuries in general and specifically for home and work related injuries, but not for road traffic injuries. The middle income group was at higher risk of traffic injuries, possibly due to their greater mobility. Injuries not only affected people’s health, but were also a great financial burden. The cost of an injury, on average, corresponded to approximately 1.3 months of earned income, increasing to 7 months for a severe injury. Ninety percent of the economic burden of injury fell on households, only 8% on government and 2% on health insurance agencies. Self-treatment was the most common way of treating injuries (51.7%), even in some cases of severe injury. There was a low rate of use of public health services (23.2%) among injury patients, similar to private healthcare (22.4%). High cost, long distances, residence in mountains, being female and coming from ethnic minorities were barriers for seeking health services. People with health insurance sought care more, but the coverage of health insurance was very low. Some prevention strategies might include education and raising awareness about the possible dangers of injury and the importance of seeking appropriate care following injury. To avoid household hazards, several strategies could be used: better light in the evening, making gravel paths around the house, clearing moss to avoid slipping, wearing protective clothing when using electrical equipment and improving kitchens. Similarly, improving road surfaces, having separate paths for pedestrians and cyclists and better driver training could reduce road accidents. In Vietnam, and especially in a rural district without any injury register system, a community-based survey of unintentional injuries has been shown to be a feasible approach to injury assessment. It gave more complete results than could have been obtained from facility-based studies and led to the definition of possible prevention strategies.

Adolescent participants (N=170) completed questionnaires assessing individual characteristics (gender, age, Sensation Seeking, Aggression/Oppositionality, Impulsivity) and characteristics of the neighbourhoods in which they live (Neighbourhood social cohesion/informal social control of youth). Postal codes as reported by the youth were linked to 2006 Canadian census data in order to determine area-level Socioeconomic Status (SES) for each adolescent. Data regarding adolescents’ individual traits and characteristics of the neighbourhoods in which they live were examined both as main effects and in individual by neighbourhood interactions as predictors of adolescents’ risk of injury. Individual traits predicted injury risk, however, neighbourhood social processes and SES did not predict adolescent injury risk when examined as main effects, whether included alone or together with individual characteristics. Neighbourhood social processes and Neighbourhood SES each moderated the relation between certain individual traits and injury risk. The value of examining individual-context interactions in injury risk research is discussed.

Unintentional injuries are the leading cause of death and disability for youth under 20, and motor vehicle collisions are the leading cause of death in youth aged 15-19 (World Health Organization, 2010). Research has consistently shown that driver education programs do not result in safer youth driving. Indeed, the biggest predictor of collisions involving youth is parental history of collisions. This dissertation comprised two studies – one to develop a measure of risky driving and one that examined the influence of parents on youth risky driving. Participants (N = 432) for both studies were undergraduate students aged 17 to 22 who had obtained their G2 driver’s licence in the past year. In Study 1, exploratory and confirmatory factor analyses of the new Youth Domains of Risky Driving Scale revealed a four-factor solution consisting of aggressive, substance use, distracted, and moving violation subscales. In Study 2, this new measure was used to evaluate relations between parental modeling of risky driving behaviours, parental teaching about safe driving behaviours, and youth risky driving. Results revealed that parental modeling was generally more predictive of youth risk than parental teaching, for all four subtypes of driving behaviours examined. Youth whose parents modeled risky driving behaviour were more likely be willing to drive in a risky manner, to expect that they would do so in the future, and to report a history of risky driving in the past. Findings from this study highlight the role parents play in the development of youth risky driving. Implications for future interventions targeting parent driving behaviour in the early months of youth licensure are discussed. / Canadian Institutes of Health Research

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